VALUE OF VOLUME FRACTION OF COLLAGEN IN DEVELOPMENT OF MYOCARDIUM REMODELING ATTHE PATIENTS WITH INFLAMMATORY CARDIOMYOPATHY

Abstract

Introduction: Morphological substrate of myocardial remodeling are processes taking place at all levels of the structural organization of the heart. One of the indicators of collagen formation is collagen volume fraction (CVF). Objectives: The purpose of the study the role of interstitial fibrosis in the myocardial remodeling in inflammatory cardiomyopathy (IC). Methods: The study included 60 patients with IC heart failure (HF) in age from 22 to 56 years (41,03±1,91 years). All the patients were determined by the method of CVF J.Shirani et al., Holter monitoring and echocardiography. Results: CVF in patients with IC was 11,1±3,1% with a range from 6 to 16%. In patients with I-II HF CVF was 9,8±3,0%, and in III-IV HF -12,7±2,5% (p<0.05) and an increase in the maximum rate of filling of the left ventricle during atrial systole V max A- 52,4±15,8 sm/s and 56,7±12,0 sm/s (p>0.05), a decrease in the rate of filling of the left ventricle during diastole Vmax E 64,1±10,9 sm/s and 60,1±11,5 sm/s(p>0.05) and the ratio E/A -1,35±0,5 and 0,5 ±1,13. In patients with expressed dilatation (LVEDD ≥5,8 sm) CVF was 13,3±2,4%, but at a moderate dilatation (LV-EDD<5.8 sm)- 9,1±2,2%(p<0,01). Multifactorial regression analysis revealed a positive correlation between CVF and LVmass index(r=0,49,p<0.001) with a thickness of the posterior wall of the left ventricle(r=0,45,p<0.01). Average value SDANN, characterizing the heart rate variability (HRV) in IC was not significantly lower than the control - 89,4 ±11,4 and 61,3±18,5 ms (r>0,5) respectively, RMSSD - 56,3±2,1ms and 37,2±11,0ms respectively(r<0,01). Percentage of pNN50 was 1,3 times lower than the norm (r>0,5). The mean values of total spectral power of HRV and the HRV power spectrum in the range of very low frequencies as compared to healthy individuals were significantly lower (p<0,05). At low and high frequencies also showed a significant reduction in the power spectrum of HRV (r<0,001). Although patients with IC showed a reduction in the ratio of LF/HF, but the differences were not identified(r>0,5). Conclusion: Thus, dependence of structural changes on the degree of fibrosis. With the increase in the relative volume area of fibrosis (due to collagen) increases myocardial systolic dysfunction. Reduced HRV to the greatest extent due to changes in the processes of myocardial remodeling indicators of structural and functional state of the heart.